Risk factors for proctectomy in consecutive Crohn's colitis surgical patients in a reference colorectal centre

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http://hdl.handle.net/10138/305247

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Aaltonen , G , Carpelan-Holmström , M , Keränen , I & Lepistö , A 2019 , ' Risk factors for proctectomy in consecutive Crohn's colitis surgical patients in a reference colorectal centre ' , International Journal of Colorectal Disease , vol. 34 , no. 8 , pp. 1401-1406 . https://doi.org/10.1007/s00384-019-03337-8

Title: Risk factors for proctectomy in consecutive Crohn's colitis surgical patients in a reference colorectal centre
Author: Aaltonen, Gisele; Carpelan-Holmström, Monika; Keränen, Ilona; Lepistö, Anna
Contributor: University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Abdominal Center
University of Helsinki, HUS Abdominal Center
Date: 2019-08
Language: eng
Number of pages: 6
Belongs to series: International Journal of Colorectal Disease
ISSN: 0179-1958
URI: http://hdl.handle.net/10138/305247
Abstract: Purpose Crohn's colitis carries a risk for permanent stoma with extirpation of the rectum. We aimed to estimate the proctectomy rate and identify risk factors for proctectomy in patients with Crohn's colitis. Methods For this study, we retrospectively reviewed data from consecutive patients with Crohn's disease (CD) affecting the colon or anorectal region undergoing bowel resection in a reference colorectal centre between 2006 and 2016. The cumulative risk for proctectomy was calculated using the Kaplan-Meier curve. We used univariate and multivariate logistic regression analyses to determine independent risk factors for proctectomy. Outcomes after proctectomy concerning reoperation frequency and perineal wound healing are also described. ResultsIn total, this study included 125 patients. Proctectomy was performed in 36 patients (28.8%), of whom 14 patients (38.9%) experienced perineal wound healing problems. The rates of proctectomy were 5.6% and 32.0% 10 and 20 years after CD diagnosis, respectively. Female gender (odds ratio (OR) 3.375, 95% confidence interval (CI) 1.304-8.733, P=0.012), disease duration (OR 1.067, 95% CI 1.011-1.126, P=0.018) and history of perianal disease (OR 3.160, 95% CI 1.215-8.219, P=0.018) were independent risk factors for a proctectomy procedure, whereas thiopurine medication (OR 0.170, 95% CI 0.060-0.486, P=0.001) was an independent protective factor for proctectomy. Conclusions The duration of Crohn's disease, female gender and a history of perianal disease were significant risk factors for a proctectomy procedure. Future research should examine whether immunosuppressive and biological medications reduce the risk for proctectomy.
Subject: Crohn's colitis
Crohn's disease
Definitive stoma
Proctectomy
Risk factors
ILEORECTAL ANASTOMOSIS
SEGMENTAL RESECTION
TOTAL COLECTOMY
DISEASE
RECURRENCE
INFLIXIMAB
AZATHIOPRINE
RECTUM
FATE
MANAGEMENT
3126 Surgery, anesthesiology, intensive care, radiology
3121 General medicine, internal medicine and other clinical medicine
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